A visual side-effect of the pandemic

The pandemic vogue for face-to-face video encounters via Zoom, Facetime and similar technologies has had some unexpected consequences. One is that it has provoked a surge in demand for plastic surgery as people spend long periods being confronted with their own visual imperfections. I have spoken to several doctors who find prolonged exposure to their own faces during video consultations as uncomfortable as wearing a face mask and favour a return to the telephone.

My personal experience of surprising visual exposure came in the course of a video review by a speech and language therapist following my recent minor stroke, when she invited me to display the movements of my tongue. We were both alarmed to discover that it had acquired an extensive unhealthy looking yellowishbrown coating. As she was uncertain about the significance of this, she suggested that I might seek further expert advice.

Being well aware that while for conventional medical practitioners the appearance of the tongue is of little interest, it is considered of major diagnostic importance in traditional Chinese medicine, I consulted my old friend Peter Mole, dean of the college of Integrated Chinese Medicine in Reading and acupuncture practitioner in Oxford.

Inspecting my tongue and taking my pulses, he confirmed that a “yellow wet tongue” suggested “liver and damp heat” and “deficiency in the pericardium and triple burner”. He recommended the application of acupuncture needles: two in the right foot, one below the knee and three more in various sites in the back.

I was somewhat disconcerted when Peter suggested that, given my condition of “liver heat”, in addition to considering further acupuncture treatment, I should forgo my daily glass or two of red wine. I thought this was the sort of advice one might expect from a conventional doctor, but I didn’t say anything. A week later, I can report that, though I am generally feeling better, my tongue looks much the same.

Stethoscope failure

For more than 200 years, the stethoscope has been such a prominent feature of medical practice that it has become a symbol of the profession. Yet given its poor performance in diagnosing coronavirus pneumonia, it now seems destined to become another casualty of the pandemic.

A recent study suggests that a few hours training in the technique of “point-of-care ultrasound” is enough to equip a novice doctor with the diagnostic skills of a consultant cardiologist.

The problem is not only that the stethoscope performs badly in detecting lung and heart disease, but also that because it is casually carried around the wards by doctors and rarely cleaned, it is a potential vector of infectious diseases such as Covid-19.

So farewell to those timehonoured “added breath sounds”: to crepitations, rhonchi and rales, to tactile vocal fremitus and whispering pectoriloquy!

As Larry Istrail, physician and advocate of ultrasound diagnosis, says: in the age of the coronavirus, “art and tradition should take a back seat to precision and uncertainty”.

Performing poorly: the stethoscope may become a thing of the past

Anti-vaxxers myth

One conspiracy theory circulating is the belief that anti-vaxx campaigners are successfully exploiting the prospect of a Covid-19 vaccine to promote their wider anti-science agenda. This is strange because, despite the hype around developments in Oxford, there is no immediate prospect of a vaccine. Further, there is little evidence that anti-vaxxers have any significant influence on current vaccine uptake. Yet for Polly Toynbee in The Guardian, the anti-vaxxers are part of a wider far-right, Brexitvoting, coronavirus-denying, mask-refusing populist upsurge.

The portentously named Centre for Countering Digital Hate wants a clamp down on antivaxx content on social media and Health Secretary Matt Hancock is keen to oblige. More resources for immunisation clinics and less political football over vaccination might benefit the public more.

Face-to-face video encounters via Zoom has led to a surge in plastic surgery